Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with NORTHWEST NEUROLOGY, LTD before sending sensitive documents. FaxFlow is not affiliated with this organization.

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NORTHWEST NEUROLOGY, LTD fax number

(847) 882-6228

Neurology

Used for: Medical records requests / authorization to release information; typically used for sending or receiving patient records, referrals, and related confirmations.

Fax destination details

Department
Neurology
Purpose
Medical records requests / authorization to release information; typically used for sending or receiving patient records, referrals, and related confirmations.
Form
Authorization to Release Information — Authorization to Release Information
Address
22285 N Pepper Rd, Suite 401, Lake Barrington, IL 60010
Voice phone
847-882-6604

Before you send

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  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Provide patient identifying details, authorize the release scope (which records to release), recipient, and expiration; sign and date the form.

Official form instructions are published as a downloadable file on the organization's website.

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